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Cigarettes remain an anathema to many physicians. Like so many unhealthy behaviors over which a clinician has little control, it can be frustrating to deal with a habit that can do so much harm to a patient, but which may be deeply entrenched in his daily life. Although the percentage of current cigarette-smoking US adults has steadily decreased from 34.1% in 1978 to 19.8% in 2007 there remains vast room for improvement. A fifty-percent reduction …

Clinical question: What should the medical work-up be for an adult newly diagnosed with uveitis?

Uveitis, defined as intraocular inflammation of the eye, can be idiopathic and limited to the eyes, or can be a manifestation of systemic inflammatory diseases and infectious diseases.

The single most common cause of uveitis is idiopathic. However, uveitis is a manifestation in spondylarthropathies, inflammatory bowel disease, Behcet’s Disease, and sarcoidosis, and may be the presenting symptom of these systemic disorders. Uveitis can …

For thousands of years, humans have been fascinated with the idea of slowing and perhaps even reversing the process of aging. From Ponce de León to modern research into substances like telomerase and resveratrol, philosophers, explorers, and scientists have dedicated countless hours to this pursuit.

Resveratrol, a substance found in the skin of red grapes and other plants such as eucalyptus, spruce, and lily, has developed a buzz for its hypothesized potential to slow the aging process in humans …

There is a stranger in the clinic room, and it is not your patient. This stranger is a multifaceted, opinionated entity with likely conflict-of-interest. This new acquaintance has already spoken to your patient and influenced the direction of this visit in the form of health statistics, symptom explanations, and feared complications. Now your patient wants to know what you think. In an age when patients will often have diagnosed their problem before they walk through a clinic door, …

Vitamin D deficiency is highly prevalent in the U.S. and worldwide, and the problem appears to be worsening. By definition, vitamin D deficiency is a serum 25-hydroxyvitamin D (25-OH D) level of less than 20 ng/mL. Vitamin D insufficiency is defined as a serum 25-OH D level from 20 to 30 ng/mL. Unless there is a high risk for fracture and a clinical suspicion of deficiency, it is not routine to screen for vitamin D deficiency, due to …

On January 11th, the New York City Health Department announced its plans for the National Salt Reduction Initiative, a public health proposal designed to decrease sodium consumption throughout the country. High levels of dietary sodium have frequently been associated with increased rates of hypertension and adverse cardiovascular events. The mean salt intake in the United States is extremely high in all age groups and well above the current recommendations of 5.8 g (2300 mg sodium) for those under …

The onset of acromegaly is subtle, and its progression is usually very slow. In fact, the usual interval from the onset of symptoms until diagnosis is about twelve years. The manifestations of acromegaly result from excessive secretion of growth hormone (GH), which targets the liver, resulting in stimulation of hepatic secretion of insulin-like growth factor-1 (IGF-1), which causes many of the clinical manifestations of acromegaly. The most common cause of acromegaly is a functional pituitary adenoma. The effects …

A healthy 18 year-old female presents to Urgent Care after slipping and falling this morning in the bathroom and hitting her head on the tile floor. She denies any loss of consciousness, vomiting, or current neurological deficits, but does have a mild occipital headache where she struck her head. She has heard a lot about recent research regarding concussions in young athletes and asks if you think she suffered a concussion and what this means for her.…

An 18-year-old male presents complaining of crampy abdominal pain, nausea, and intractable vomiting for the past year. The symptoms are episodic, lasting several weeks and remitting for weeks to months. The patient states that his abdominal pain is 10 out of 10 in severity, and that he has been vomiting up to 20 times each day. He has been evaluated at multiple hospitals, and he has had numerous upper endoscopies, colonoscopies, swallowing studies, and …

When the New Jersey legislature approved a measure to legalize the use of marijuana for patients with chronic illnesses early this year, multiple sclerosis (MS) patient Charles Kwiatkowski, of Hazlet, N.J., rhetorically asked the New York Times; “The M.S. Society has shown that this drug will help slow the progression of my disease. Why would I want to use anything else?”1 New Jersey was the 14th state in the nation to approve such legislation. Does the drug …

A 29-year-old female patient with a history of iron deficiency anemia and heavy menstrual periods comes into the clinic for a regular visit. She is tired of iron supplementation and its associated constipation. As she is currently on oral contraceptive pills, you recommend using these to reduce her menstrual period to four times a year. She asks, “Is that really safe?”

Is menstruation necessary?

Monthly menstruation is not the historical norm. Compared with modern women, women in prehistoric …

In a bold move, the U.S. Preventive Services Task Force recently changed their breast cancer screening guidelines – recommending beginning screening at age 50 and even then only every other year until age 75. Bold, because the Task Force members are certainly aware of the media circus that ensued when in 1997, an NIH group issued similar guidelines, prompting comparisons to Alice in Wonderland. The new guidelines, recommend “against routine screening mammography in women aged 40-49 years” as well as …

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